腹腔镜在减少儿童隐匿性腹股沟斜疝与鞘膜积液二次手术的意义

Clinical significance of laparoscopic technique in reducing secondary surgery of occult inguinal hernia and hydrocele of children

目的探讨腹腔镜技术在减少术前诊断为单侧腹股沟斜疝与鞘膜积液的儿童因对侧隐性病变造成二次手术的意义。方法回顾性分析上海交通大学医学院附属上海儿童医学中心近10年来12892例术前诊断为单侧腹股沟斜疝与鞘膜积液患儿的治疗情况。其中传统开放手术4726例,仅处理患侧病变,对侧不做探查。术后统计对侧再次出现疝或鞘膜积液需二次手术的例数以及两次麻醉的总时间。腹腔镜手术8166例,术中探查若发现对侧内环口开放则一并结扎,记录麻醉时间。比较两种手术方式的疗效与麻醉时间。结果开放手术后6.9%的患者对侧再次出现疝或鞘膜积液,需二次手术,麻醉总时间(52.4±20.4)min。腹腔镜手术中探查发现21%的对侧内环口开放,麻醉时间(32.7±10.2)min。两组比较麻醉时间差异有统计学意义(P<0.001)。结论对于术前诊断为单侧疝与鞘膜积液的患儿,腹腔镜技术能有效诊疗对侧隐性病变,减少麻醉次数和时间,符合微创理念,值得临床推广应用。

Objective To investigate the significance of laparoscopic technique in reducing secondary surgical injury caused by contralateral occult lesions in children with unilateral inguinal hernia and hydrocele compared with traditional open surgery.Methods The data of 12892 children with unilateral hernia and hydrocele diagnosed preoperatively in Shanghai Children's Medical Center Affiliated to the School of Medicine of Shanghai Jiaotong University in recent 10 years were retrospectively analyzed.In 4726 cases,traditional open surgery was performed only on the affected side without exploration on the contralateral side.The number of contralateral recurrence cases requiring reoperation and the total duration of two anesthetics were counted during postoperative follow-up.In 8166 cases of laparoscopic surgery,intraoperative exploration and ligation were performed if the contralateral inner ring was opened,and the duration of anesthesia was recorded.The efficacy and duration of anesthesia were compared between the two methods.Results After open surgery,6.9%patients had contralateral recurrence,requiring a second operation,and the duration of anesthesia was(52.4±20.4)min.During laparoscopic surgery,21%of the contralateral inner ring was found open,and the anesthesia duration was(32.7±10.2)min.There were significant differences in anesthesia time between the two groups(P<0.001).Conclusions For children diagnosed with unilateral hernia and hydrocele before surgery,laparoscopic technology can effectively diagnose and treat contralateral occult lesions,reduce the times and duration of anesthesia,which is eligible for the concept of minimally invasive,and is worthy of clinical application.